Y4 - Mood Disorders Flashcards
Additional info only
For which patients may mirtazapine be a good antidepressant?
Helps with anxiety symptoms, sleep and appetite
When do you know an antidepressant isn’t working?
If it doesn’t work after 8 weeks at the max/max tolerated dose
Define mania
Abnormally heightened mood associated with increased activity
In what context is mania usually seen?
BPAD or manic depression
How might someone with mania appear/behave?
Bizarrely dressed, inappropriate bright clothing
Animated, constantly moving
Overfamiliar, disinhibited, distractible, may become aggressive
How might someone’s speech and thought form be if they are manic?
Rapid, pressured, punning, clang associations
Flight of ideas
How might a manic person’s mood be?
Elated, irritable, angry
What may be included in a manic person’s thought content?
Unrealistic preoccupations, optimistic schemes
If psychotic may have grandiose/religious delusions
How might a manic person’s perceptions differ?
Mood-congruent hallucinations
How are the insight, judgement and cognition impacted in mania?
Insight and judgement very poor
Cognition usually unaffected
What investigations should you do in mania?
Collateral hx
Review old notes
Urine for drugs, glucose, UE, FBC, TFT
What are the classifications of mania?
Hypomania
Mania
Mania with psychotic features
What are the aetiologies of mania?
Biological, strong FH of BPAS/depressive disorder
Life events little relationship to onset
Organic causes, e.g. child birth, steroids, thyrotoxicosis
How common is mania?
1% of population
What is the proposed pathology behind mania?
Monoamine dysfunction
What are the complications of mania?
Suicide (15%)
Relationship problems
Loss of reputation, job
Consequences of risky behaviours (STIs, trauma, debts)
What are some differentials for mania?
Normal emotional reaction Schizophrenia Mood disorder Anxiety disorder Endocrine: hyperthyroidism, excessive steroids Medication and substance use Cerebral infection/infarction/trauma/tumour/temporal lobe epilepsy Neoplasm
What is the management of mania?
Acute - sedatives (e.g. benzos), antipsychotics and mood stabilisers
Long term - lithium, anticonvulsants, antipsychotics, antidepressants
What is poor prognosis in mania linked to?
Duration, severity, time, frequency, time to effective treatment, psychological dysfunction/PD, substance use
What is bipolar disorder?
At least two episodes of hypomania/mania and depression
How long do manic episodes tend to last for?
Anywhere between 2 weeks and 4-5 months
Median: 4 months
